title: Clinical venous thromboembolism following joint surgery: effect of extended thromboprophylaxis on its annual frequency and postoperative pattern over 22 years.
abstract: We describe annual incidences and 6-month postoperative patterns of clinical venous thromboembolism (VTE) in 9078 patients undergoing major joint surgery in a Scandinavian hospital. In cohort I (1989-1999), low-molecular-weight heparin thromboprophylaxis for 7 to 10 days was uniformly introduced, 5-week thromboprophylaxis becoming routine after total hip replacement (THR), partially applied after hip fracture surgery (HFS), but not used after total knee replacement (TKR) thereafter (2003-2011; cohort II). Mean annual VTE incidence was lower in cohort II than in cohort I after THR and HFS but not after TKR. In cohort I, the cumulative VTE incidence increased sharply during the first 5 postoperative weeks in all groups, subsequently plateauing up to 6 months postsurgery. In cohort II, this incidence remained low and stable during 5 weeks post-THR, rising gradually up to 6 months, with a comparable but less pronounced pattern following HFS but not TKR. In conclusion, the VTE risk after major joint surgery seems to persist after 5- and 1-week prophylaxis in patients undergoing hip surgery and TKR, respectively.
authors.affiliation: 1Centre of Medical Science, Education and Innovation, Innlandet Hospital Trust, Brumunddal, Norway.
authors.forename: Ola E
authors.initials: OE
authors.lastname: Dahl
authors.forename: Tor E
authors.initials: TE
authors.lastname: Gudmundsen
authors.forename: Are H
authors.initials: AH
authors.lastname: Pripp
authors.forename: Joakim J
authors.initials: JJ
authors.lastname: Aanesen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011184:Postoperative Period; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
keywords: clinical epidemiology; deep vein thrombosis; low-molecular-weight heparin; pulmonary embolism; thrombosis prophylaxis; venous thromboembolism